Provider Demographics
NPI:1467456004
Name:HANNUM, BRIDGET A (PHD, APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:A
Last Name:HANNUM
Suffix:
Gender:F
Credentials:PHD, APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NORTHWESTERN UNIVERSITY 633 EMERSON
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60208-1826
Mailing Address - Country:US
Mailing Address - Phone:847-467-6990
Mailing Address - Fax:
Practice Address - Street 1:NORTHWESTERN UNIVERSITY 633 EMERSON
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60208
Practice Address - Country:US
Practice Address - Phone:847-467-6990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004151363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health